Fusarium oxysporum Endogenous Endophthalmitis After Allogeneic Hematopoietic Stem Cell Transplantation

Fusarium is an uncommon cause of fungal endogenous endophthalmitis (FEE), especially in immunocompromised patients. So far, only two species of Fusarium (Fusarium solani and dimerium) have been associated with FEE. To the best of our knowledge, Fusarium oxysporum has not been reported as a cause of FEE previously. We describe a case of FEE due to Fusarium oxysporum without associated disseminated fusariosis in a patient of hematopoietic stem cell transplantation (HCT).

A young male patient presented with a sudden diminution of vision in the left eye (LE). Ocular examination of the LE revealed a best-corrected visual acuity of 20/120, 2+ cells, mild vitritis, and superficial necrotizing retinitis-like lesions at the posterior pole. The right eye was unremarkable. Systemic history revealed a recent history of HCT for aplastic anemia. He was on systemic immunosuppressants for prophylaxis of graft versus host disease.

An intravitreal ganciclovir was injected initially, suspecting LE CMV retinitis. However, the vitreous tap microbiological examination and PCR were negative. Detailed laboratory evaluations were unremarkable. As the LE condition continued to worsen, he underwent pars plana vitrectomy and intravitreal antibiotics and antifungals in LE. Vitreous biopsy culture revealed Fusarium oxysporum. He was aggressively treated with topical, repeat intravitreal, and systemic anti-fungal medications. Despite multifaceted treatment, the LE progressed to total retinal detachment without any salvageable vision.

This report illustrates the first case of Fusarium oxysporum-associated FEE in an HCT patient and highlights the diagnostic challenges, need for early aggressive treatment, and poor outcome in such cases.